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Linda Collins Blogger

How to Bill Repairs

Posted by Linda Collins | February 06, 2018

Your patient returns with an orthotic or prosthetic device that needs repair. The manufacturer's warranty no longer covers the product. How are you paid for your time and materials? When an orthosis or prosthesis has to be repaired, and is no longer under warranty, there are specific labor and parts codes you can use.

Cost of labor:

L4205 REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER 15 MINUTES

L7520 REPAIR PROSTHETIC DEVICE, LABOR COMPONENT, PER 15 MINUTES

Cost of parts:

HCPCS code of the base product AND

L4210 REPAIR OF ORTHOTIC DEVICE, REPAIR OR REPLACE MINOR PARTS

L7510 REPAIR OF PROSTHETIC DEVICE, REPAIR OR REPLACE MINOR PARTS

*Bill these codes in 15-minute increments for actual time involved in repairs. (If the repair is required within the applicable warranty period for the device, it is included in the initial cost of the device.) If the labor time involved in the repair is 30 minutes, you will bill 2 units of the code.

Example:

A patient returns with a broken strap on a knee brace. Your repair claim may include:

L1843 KX, LT, RB

L4210, 1 unit

L4205, 2 units

L4210 and L7510 are to be used for minor parts that do not have HCPCS codes.

When billing one of the repair codes, you must explain what you are repairing and provide a narrative description of the base items. You should also document how long the repairs took. For the claim, enter the explanation of repair in Item 19 on the HCFA 1500 or its electronic equivalent. Provide sufficient explanation of the time and repairs.

The box 19 field is limited to 71 characters so it is necessary to be concise and use abbreviations. For example, "rpl hng tghn stp 15m" may be used to describe replacing a hinge and tightening a strap which took 15 minutes of time. Medicare does not offer suggested abbreviations but suggest suppliers be creative in their descriptions.

Medically Unlikely Edits (MUE) are active for the repair codes. This means the Medicare claims processing software may automatically deny the claim after a certain amount of units. For L4205 the number of units is eight. For L7520, the number of units is 12.  If you receive a MUE, and you have sufficient documentation to support your repair time, you can request a reconsideration of the denied claim. Be sure, your notes detail the time and materials used in the repairs.

A few other reminders:

  • A new physician's order is not needed for repairs
  • Use RT or LT modifiers on the HCPCS to identify the device
  • Repairs are not paid on devices previously denied by Medicare
  • Items and services covered under a manufacturer's warranty are not billable to Medicare.
  • Use the RA modifier when there is a replacement of a DMEPOS item, due to loss, irreparable damage, or theft.
  • Use the RB modifier for replacement parts furnished in order to repair the DMEPOS item.

What does this mean for you?

You can provide necessary repairs for your patients and bill for time and materials. Be sure to document the time involved, the details of the repair, and the specific parts used.

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